More on Bipolar 2 and Self Care

Calling Bipolar 2 the softer version of Bipolar 1 is not quite accurate. It might be easier to hide and avoid hospitalization. And aside from actual suicide attempts, you are less likely to land in the emergency room. But Bipolar 2 actually has a higher suicide risk than both Bipolar 1 and Major Depression. Of the three, over a lifetime you spend the longest time depressed. Sprinkled throughout are higher energy times when you might actually have the willpower to kill yourself.

You don’t exactly swing between happy and sad states.  To describe from my own experience, which seems fairly close to textbook Bipolar 2, it is more accurate to say you swing between low and high energy states, with the vast majority spent in low. Note that low doesn’t necessarily mean sad, nor does high mean happy. Low states might be lethargy and way too much sleep, it might even feel comfortable in a weird way.  High energy states can bring happy and productive hypomania, but this is woefully infrequent. More likely they arrive with high strung anxiety, irritability, and explosive anger. 

At first glance the more serious depressive episodes might look indistinguishable from major depression but apparently the latter is more likely to suffer from sleep disturbance and insomnia. Also bipolar depression tends to have a much earlier onset in life. In my case the first major episode was at age 13.

Unfortunately most available information on Bipolar paint a simplified picture. Describing it as a fairly well defined chemical imbalance of the brain that must be controlled lifelong with mood stabilizers. For some these might be life saving, but they are probably a subset of the diagnosed. We don’t try all the other less invasive and about as effective methods available. Sometimes societal pressure and stress don’t give us a choice. It also doesn’t help that there’s no money to be made in these lifestyle tweaks.

The following are my own self care strategies (aside from therapy and/or medication) that seem to help.

Regular routine (sleep, meals, work, social activities…)
Exercise
Sunlight
Someone to talk to
Low stress (not living up to my “potential”)
Writing, music
No alcohol
Dark therapy

Interestingly this is pretty close to what people with bipolar self report worked according to a 23andme survey. (https://blog.23andme.com/23andme-research/what-patients-say-works-for-bipolar-disorder/)

Bipolar is not only a problem with mood regulation. There are also executive functioning deficits. Once you are out of the thickets there is still much work to do.  Personally, I still need to put in a lot of effort in decision making, focus, goal setting, and social contact.

All these do not require any money or prescription and they carry no risks. But they do require changing your habits and you just may not have the energy to do so. I was only able to get to the point of self care deterring further episodes after years of therapy and constant support from my spouse. But as mentioned before, I still struggled with mild mood problems, low energy, brain fog, and occasional explosions, among others. The final key, the point of this whole blog, was diet.

There is increasing evidence that mental disorders are connected to inflammation, particularly of the gut. The source of this inflammation may differ from person to person, but in my case undiagnosed allergies and sensitivities seem to have played a key role. That the brain and gut and immune system all influence each other may have at one point been dismissed as wild speculation but in recent years there was a game changing discovery of a direct physical connection between the brain and immune system. (http://www.nature.com/articles/nature14432.epdf) Toppling the notion thus far that the brain was immune privileged.

Now I am at a point that I didn’t know I’d ever get to. I am on an even keel, almost saintly sometimes. I seem to have many times more energy and clarity. At most I might have mildly low mood for a day or two after tiny accidental ingestion of some problem foods.

Mental Health History

Despite a slew of physical complaints and being in and out of the hospital from time to time, my greatest ongoing struggle was with bipolar type 2, according to the current diagnostic system.

The first inkling that something might be slightly amiss was around age 8 when I saw visions and heard voices near daily. This went on for a couple of years but other than that I was a normal, energetic, sometimes extremely persistent kid.

I started to feel a bit numb and fixated on what adults expected of me around age 12, but clear trouble showed up when I was 13. For a couple of years I was miserable, anxious, and just barely holding myself back from suicide with the irrational belief that I would fail at killing myself and make life even worse.

From 15 to 21 I didn’t quite get actively suicidal again, but most of the time I was mild to moderately depressed with occasional dips into more serious territory.

Around 22 I had a lot of angry outbursts, which was new to me, then just before turning 23 I started getting rapid mood swings. By then I was very familiar with depression but mood and energy levels swinging between extremes sometimes within the same day was disorienting and truly alarming. I finally sought help. 

I was prescribed Depakote, a mood stabilizer and anticonvulsant along with a preliminary diagnosis of emerging bipolar. The desperation wasn’t enough to get myself to actually take the medication. In part because my experience with illness and hospitals thus far told me I tend to get every side effect listed on a pill bottle, which most would think is a remote possibility. And the lists that psychiatric medications carry is usually not pretty. 

Instead, with some help I found a therapist who was willing to work with me long term. But even she was tested to the limit about my decision to not take medication. It took months to pull out of the worst mood swings. And then years of therapy to get me functioning at near normal, that is, no longer meets diagnostic criteria. I was extremely lucky to have a great insurance plan at the time.

And now I am extremely lucky to have a spouse who supports me and lets me live a very low stress life. I could structure my day as I wished. I learned everything I could about what will help keep me relatively stable. I tried to sleep regularly, kept a very routine existence, I walked most mornings to get sun and exercise, even tried to keep social schedules fairly even and predictable. My spouse was great whenever I seemed to slip. He would drag me out of bed, push me to shower, take me out to walk, or to eat out, whatever it took to stop the onset of a familiar low mood. 

It can’t be said enough how grateful I am for this good fortune that most people with similar mental struggles just aren’t afforded with. In this near ideal environment we managed to avoid any further major episodes, but there was still something wrong. I felt most of the time borderline mildly depressed, always at risk of slipping further. I would sometimes get bouts of energy and come up with a whole bunch of ideas but never get them done. Even with all the time I had, home was a mess and I still struggled to cook one meal a day. Every mundane decision was so difficult. I constantly struggled with feeling stuck, keeping focus, and general laziness due to lack of motivation and low energy. I assumed these might be the lingering habits of depression from much of my formative years and this ongoing private struggle was my lot in life.

So I was shocked that these lifted when I avoided gluten. About a week in I felt more clarity and energy than I had in a long time. It was like a little glimpse into what life was supposed to feel like, what I was missing all this time. Then after another week, we did a gluten challenge. A couple of hours after pizza I felt irritable. But for a full day we kept eating pasta and bread. I kept getting irritated at the slightest things. Just the day before I had so much fun brainstorming all the things I could do, and now my pencil was stuck on the first line, whether I should get some groceries today or not, for a full hour. 

This was a huge discovery. By banning gluten, or maybe it’s wheat, I got my brain back. 

And then I started to learn a whole host of new things about my body. It seems not just my brain but my whole nervous system was dulled by some reaction to wheat. I had more than my fair share of familiarity with the hospital system throughout my life, most of them, mysterious cause unknown inflammation of organs, some severe enough to require surgery, hospitalizations, or long term treatment. And now for the first time I could discern patterns between my various physical symptoms and food, and mold, etc. In short, I had a whole host of various allergies, both the immediate and delayed types, some mostly localized to the gastrointestinal tract like FPIES (food protein-induced enterocolitis syndrome). 

I also found that high free glutamate foods seem to trigger hypomania. Similar to how the combination of food and exercise can cause allergic reactions (FDEIA: food dependent exercise induced anaphylaxis, for example) the combination of an allergen and high free glutamate seems to bring on migraine in my case. But when I’m successfully avoiding all foods I am allergic to, natural free glutamate, and even MSG (monosodium glutamate), by itself does not seem to cause any symptoms but excites the body. Even one meal of high glutamate can give me such a buzz that I cannot sleep for almost three days straight.

Some of you may know that bipolar people have a reduced expected life span of more than ten years even when we remove those who commit suicide. What we think of as mental illness, is very likely a physical illness with the most worrisome symptom being that of the brain malfunctioning.

The Short

I never imagined I had any food issues until I trialled a gluten free diet to support my partner. I suffered from major depressive episodes since I was thirteen and in my early twenties was diagnosed with emerging Bipolar. Fortunately with plenty of help I was able to keep further episodes at bay but was prone to being mildly depressed. And now for the first time in my adult life I experienced clarity and energy and many physical symptoms that I always lived with disappeared.

And the surprises kept coming. My body started to feel more clearly when something was causing a problem. Within a few weeks I recognized I was allergic to mold and milk, later confirmed through testing. In the following three years I continued to learn more about my own body and about less typical manifestations of allergies in general. I am still astonished by how even severe reactions can somehow be masked enough that it is nearly impossible to pinpoint the cause despite ongoing suffering.

I feel there are still many unknowns and a large gap between research and what is known in the mainstream. The immune system going awry just might be the culprit behind a large subset of unexplained and usually chronic conditions, both mental and physical. Here, I will try to document what I am learning and my speculations.